Listeria monocytogenes Associated with Pasteurized Chocolate Milk, Ontario, Canada.

In an investigation of a listeriosis outbreak in Ontario, Canada, during November 2015-June 2016, pasteurized chocolate milk was identified as the source. Because listeriosis outbreaks associated with pasteurized milk are rare in North America, these findings highlight that dairy products can be contaminated after pasteurization.

Clinical manifestations of reported Lyme disease cases in Ontario, Canada: 2005-2014.

Lyme disease (LD) is the most common vector-borne disease in Ontario, Canada. We describe the epidemiology and clinical manifestations of LD in Ontario and examine trends in the incidence of non-disseminated and disseminated LD. LD surveillance data from the integrated Public Health Information System (iPHIS) from 2005-2014 were mapped to symptoms according to syndrome groups (erythema migrans (EM), flu-like, cardiac, neurologic or arthritic) and disease stages (early localized, early disseminated or late disseminated). During the study period, 1,230 cases due to Borrelia burgdoferi were reported in Ontario with annual incidence rates ranging from 0.32 (2006) to 2.16 (2013) cases per 100,000 population. Seventy percent of cases had EM and the proportion of cases with EM increased over time. Other clinical manifestations included flu-like (75%), arthritic (42%), neurologic (41%) and cardiac (6%) symptoms. Early localized disease (n = 415) manifested with EM (87%) and flu-like (57%) symptoms; early disseminated disease (n = 216) manifested with neurologic (94%), cardiac (10%) and EM (63%) symptoms; and late disseminated disease (n = 475) manifested with EM (62%), neurologic (55%), cardiac (9%), and arthritic symptoms (i.e., arthralgia (93%) and arthritis (7%)). Early localized and early disseminated cases (88% each) occurred primarily from May through September, compared to late disseminated cases (81%). The proportion of cases reported to public health within 30 days of illness onset increased during the study period, while the proportion of cases reported within 1-3 months and >3 months decreased. Geographical variations characterized by higher incidence of early localized disease and earlier public health notification (within 30 days of illness onset) occurred in regions with established or recently established LD risk areas, while later public health notification (>3 months after illness onset) was reported more frequently in regions with recently established or no identified risk areas. This is the first study to describe the clinical manifestations of LD in Ontario, Canada. The observed geographical variations in the epidemiology of LD in Ontario reinforce the need for regionally focused public health strategies aimed at increasing awareness, promoting earlier recognition and reporting, and encouraging greater uptake of preventive measures.

Data-driven approach of CUSUM algorithm in temporal aberrant event detection using interactive web applications.

OBJECTIVE: In 2014/2015, Public Health Ontario developed disease-specific, cumulative sum (CUSUM)-based statistical algorithms for detecting aberrant increases in reportable infectious disease incidence in Ontario. The objective of this study was to determine whether the prospective application of these CUSUM algorithms, based on historical patterns, have improved specificity and sensitivity compared to the currently used Early Aberration Reporting System (EARS) algorithm, developed by the US Centers for Disease Control and Prevention. METHOD: A total of seven algorithms were developed for the following diseases: cyclosporiasis, giardiasis, influenza (one each for type A and type B), mumps, pertussis, invasive pneumococcal disease. Historical data were used as baseline to assess known outbreaks. Regression models were used to model seasonality and CUSUM was applied to the difference between observed and expected counts. An interactive web application was developed allowing program staff to directly interact with data and tune the parameters of CUSUM algorithms using their expertise on the epidemiology of each disease. Using these parameters, a CUSUM detection system was applied prospectively and the results were compared to the outputs generated by EARS. The outcome was the detection of outbreaks, or the start of a known seasonal increase and predicting the peak in activity. RESULTS: The CUSUM algorithms detected provincial outbreaks earlier than the EARS algorithm, identified the start of the influenza season in advance of traditional methods, and had fewer false positive alerts. Additionally, having staff involved in the creation of the algorithms improved their understanding of the algorithms and improved use in practice. CONCLUSION: Using interactive web-based technology to tune CUSUM improved the sensitivity and specificity of detection algorithms.

Multi-Province Listeriosis Outbreak Linked to Contaminated Deli Meat Consumed Primarily in Institutional Settings, Canada, 2008.

A multi-province outbreak of listeriosis occurred in Canada from June to November 2008. Fifty-seven persons were infected with 1 of 3 similar outbreak strains defined by pulsed-field gel electrophoresis, and 24 (42%) individuals died. Forty-one (72%) of 57 individuals were residents of long-term care facilities or hospital inpatients during their exposure period. Descriptive epidemiology, product traceback, and detection of the outbreak strains of Listeria monocytogenes in food samples and the plant environment confirmed delicatessen meat manufactured by one establishment and purchased primarily by institutions was the source of the outbreak. The food safety investigation identified a plant environment conducive to the introduction and proliferation of L. monocytogenes and persistently contaminated with Listeria spp. This outbreak demonstrated the need for improved listeriosis surveillance, strict control of L. monocytogenes in establishments producing ready-to-eat foods, and advice to vulnerable populations and institutions serving these populations regarding which high-risk foods to avoid.

Assessing secondary attack rates among household contacts at the beginning of the influenza A (H1N1) pandemic in Ontario, Canada, April-June 2009: a prospective, observational study.

BACKGROUND: Understanding transmission dynamics of the pandemic influenza A (H1N1) virus in various exposure settings and determining whether transmissibility differed from seasonal influenza viruses was a priority for decision making on mitigation strategies at the beginning of the pandemic. The objective of this study was to estimate household secondary attack rates for pandemic influenza in a susceptible population where control measures had yet to be implemented. METHODS: All Ontario local health units were invited to participate; seven health units volunteered. For all laboratory-confirmed cases reported between April 24 and June 18, 2009, participating health units performed contact tracing to detect secondary cases among household contacts. In total, 87 cases and 266 household contacts were included in this study. Secondary cases were defined as any household member with new onset of acute respiratory illness (fever or two or more respiratory symptoms) or influenza-like illness (fever plus one additional respiratory symptom). Attack rates were estimated using both case definitions. RESULTS: Secondary attack rates were estimated at 10.3% (95% CI 6.8-14.7) for secondary cases with influenza-like illness and 20.2% (95% CI 15.4-25.6) for secondary cases with acute respiratory illness. For both case definitions, attack rates were significantly higher in children under 16 years than adults (25.4% and 42.4% compared to 7.6% and 17.2%). The median time between symptom onset in the primary case and the secondary case was estimated at 3.0 days. CONCLUSIONS: Secondary attack rates for pandemic influenza A (H1N1) were comparable to seasonal influenza estimates suggesting similarities in transmission. High secondary attack rates in children provide additional support for increased susceptibility to infection.

Beyond adolescence exploring Canadian women and men's perception of overweight.

PURPOSE: The research literature strongly corroborates that desires and attempts to lose weight are more prevalent among women who are already within the healthy weight range than men. The development of a distorted weight perception, specifically an overestimation of one's body size, may manifest into caloric restriction and other disordered eating behaviors. However, there is no systematic process to monitor the prevalence of disordered eating behaviors in Canada. The objective of this study was to investigate the prevalence and the sociodemographic characteristics of Canadian adults who have a perception of being overweight when their body mass index indicates that they are normal or underweight based on self-reported heights and weights. METHODS: The responses to the 2000/2001 Canadian Community Health Survey by a representative sample of Canadians between the ages of 20 and 64 were analyzed. Bivariate and logistic regression analyses were performed. RESULTS: The prevalence of perceiving oneself as overweight when at acceptable weight for height was 23.6% for women and 7.8% for men. The probability was significantly greater in women, some foreign-born residents, those with a higher income level, and with increasing age. CONCLUSIONS: These results suggest that, in contrast to mainstream thinking, distorted weight perception is experienced by adult and aging women, and not only by adolescent girls. More research is needed to understand why distorted weight perception increases with age in women and what potential adverse effects it may have in this population.